The accurate and precise placement of a needle-like instrument according to plan based on medical images, such as computed tomography (CT) and Magnetic Resonance Imaging (MRI), is critical in percutaneous interventions. To reduce placement error of the instruments and user dependency, different systems have been disclosed.
EP 2561821 discloses a tool placement manipulator that supplies a physical guidance, i.e. a needle holder, to the planned orientation with the planned skin entry point. Physicians create needle trajectory plans by using medical images of the patient. The manipulator including a robotic arm is mounted on a floor near to a medical imaging machine. The manipulator is associated with a movable patient bed of the medical imaging machine and locates the physical guidance to the target position/orientation by calculating command to the robotic arm.
U.S. Pat. Pub. 2007/0276407 discloses another tool placement manipulator that supplies physical guidance. The manipulator is mounted on the patient bed and directs the physical guidance to the target. These systems are fixed with respect to a coordinate system of the bed or the medical imaging machine. Therefore, the position accuracy or precision are sensitive to the patient dislocation. Moreover, the subsystem that supplies the physical guidance tends to become bulky since this subsystem needs to include a mounting part from the floor or the bed and thus potentially hampers physicians' line of flow in interventions.
To improve this issue, different systems have been disclosed. For example, U.S. Pat. Pub. 2006/0229641 provides a patient-mount tool placement manipulator. The subsystem that supplies the physical guidance is mounted on a patient skin. Placing the subsystem on the patient skin can decrease the sensitivity of the position accuracy or precision to the patient dislocation. Also since this subsystem does not involve the mounting part from the floor, the bed or the ceiling, the subsystem can have less chance to encumber the physicians' line of the flow in the interventions. However, this system is still limited. The tool placement manipulator in this publication does not have an opening to an insertion point of a patient's skin from natural line of physicians' sight. So physicians have to involve limitations to see and to touch the insertion point with this system. Moreover, the manipulator includes the motors that are in sockets on the movable arc-shaped parts near to the needle holder. When the motors are mounted on the sockets, the cables of these motors also extend from the sockets to the control part. These motors, the sockets and the cables potentially hamper physicians' line of flow in interventions.
A solution to these issues was provided in U.S. Pat. No. 9,222,996, herein incorporated by reference in its entirety. A system having two ring shaped rotary guides, where the second ring shaped rotary guide is slanted with respect to the first ring shaped rotary guide. Motorized actuators, that include piezoelectric actuators, rotary sliders, and ultrasonic motors, as well as simply manually rotating the first and second rotary guides. However, the cost of the motorized actuators can be high, and does not aid in creating a device that can be sterilized.
Thus, there is need for a tool placement manipulator that overcomes the deficiencies as described herein.